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Essential Skills for Mental Health Care

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Essential Skills for Mental Health Care Essential Skills for Mental Health Care By Dr Jim Crabb and Emma Razi Illustrations by Molly Cooke Front cover by Mr Abdallah JoJo Peter 2 Essential Skills For Mental Health Care By Dr Jim Crabb and Emma Razi With special thanks to: Dr Akwasi Osei Acting Chief Psychiatrist and Medical Director of Accra Psychiatric Hospital Dr Anna Dzadey Medical Director of Pantang Hospital Mabel Eshun Regional Coordinator of community psychiatric nurses, Greater Accra Rosemary Mutako Deputy Regional Coordinator of community psychiatric nurses, Greater Accra Rev. Joseph Abotsi Community Psychiatric Nurse in charge of Ablekuma Sub-metro Agnes Sam Community Psychiatric Nurse in charge of Okaikoi Sub-metro Philomena Nkansah Community Psychiatric Nurse in charge of Ashiedu Sub-metro Winfred Darko Community Psychiatric Nurse Mary Anago Community Psychiatric Nurse Agnes Akpey Community Psychiatric Nurse The authors would like to thank the Founding Director of BasicNeeds; Mr Chris Underhill, MBE and the West Africa Representative; Mr Lance Montia for their valuable assistance which made the production of this manual possible. Mr Abdallah JoJo Peter is a talented artist currently working in Accra, Ghana. He kindly provided the artwork for the front cover of this manual. Mr Abdallah JoJo Peter has schizophrenia. However, with the right treatment and care, he is stabilised and is able to lead a fulfilling and happy life. 1st Edition, September 2007 Copyright © 2007 Dr Jim Crabb Permission granted to reproduce for personal and educational use only. Commercial copying, hiring, lending is prohibited. 3 Preface This manual will prove to be a very good companion to the student of mental health including medical students, nursing students and clinical psychology students. It will also benefit the professional mental health practitioner including doctors of psychiatry, psychiatric nurses and clinical psychologists. As the title indicates, the manual contains the ‘essential skills’ necessary for mental healthcare. It is not a textbook and is not intended to replace textbooks in psychiatry. Instead it focuses on the day to day skills one would need in the field, at the clinic or on the ward. Dr Jim Crabb, the principal author, has practiced psychiatry in Ghana for three months during 2007. He worked at Pantang Hospital, at a number of polyclinics in Accra as well as in a number of remote districts in the Upper East Region. His acute observation in this short period and his rapid assessment of our needs and situation on the ground have prompted and informed the writing of this manual. The recommendations he has provided are relevant and noteworthy. Dr Crabb's stint in Ghana has been part of a BasicNeeds programme to find short-term expatriate mental health workers to alleviate a limited human resource in Ghana. This manual is a welcome collaboration between BasicNeeds and the Ghana Health Service. The manual has also been enriched by the editorial work of Ms Emma Razi, a healthcare communication specialist and the wife of Dr Crabb. The reader of this manual will surely enrich his or her skills in mental healthcare. Dr Akwasi O. Osei Acting Chief Psychiatrist Ghana Health Service 4 For Mr O. Lamptey 5 Contents Page Number Foreword 8 a) How to use this manual 8 b) DON’T PANIC! Having a crisis plan 9 Chapter 1: An introduction to mental illness 1.1 What is mental health and mental illness? 11 1.2 Why should we be interested in mental illness? 11 1.3 What causes mental illness? 12 Chapter 2: Assessing someone with mental illness 2.1 Before the assessment 14 2.2 During the assessment 15 2.3 Important questions to ask 16 2.4 Important things to observe and record (the mental state examination) 19 2.5 The physical health check 20 2.6 Getting the whole story 22 Chapter 3: Treatments for mental illness 3.1 Medicines (biological treatment) 23 3.1.1 The golden rules of mental illness and medicine 24 3.2 Talking cures (psychological treatment) 27 3.2.1 Counselling 28 3.2.2 Problem solving work 28 3.2.3 Relaxation and breathing work 30 3.2.4 Crisis planning 31 3.2.5 Coping strategies 31 3.2.6 Different ways of looking at a situation 33 3.3 Building the best life possible (social treatment) 34 3.3.1 How to rebuild a person’s life 34 3.3.2 Working with a person’s family 35 3.3.3 Relapse prevention 37 Chapter 4: The different types of mental illness 39 6 Chapter 5: Organic mental illness 5.1 Delirium 42 5.2 Epilepsy 45 5.3 Dementia 51 Chapter 6: Substance misuse 55 Chapter 7: Psychosis 65 Chapter 8: Mood disorders 8.1 Depression 70 8.2 Mania and manic depression (bipolar mood disorder) 75 Chapter 9: Anxiety disorders 9.1 Panic attacks, phobias and generalised anxiety disorders 80 9.2 Obsessive compulsi ve disorder (OCD) 84 9.3 Acute stress reactions 88 9.4 Post traumatic stress disorder (PTSD) 89 9.5 Medically unexplained symptoms (somatisation) 92 Chapter 10: Mothers and babies 97 Chapter 11: Mental retardation 102 Chapter 12: Mental illness and young people 107 12.1 Enuresis and encopresis 108 12.2 Attention deficit hyperactivity disorder (ADHD) 111 12.3 Conduct disorder 115 12.4 Depression in young people 117 12.5 Child abuse 118 12.6 Specific learning difficulties (SLD) 121 Chapter 13: Mental illness and old age 123 Chapter 14: Headaches 124 Chapter 15: Emergencies due to medicines 7 15.1 Acute dystonic reactions 129 15.2 Anti-psychotic induced Parkinsonism (AIP) 129 15.3 Akathisia 130 15.4 Tardive dyskinesia (TD) 130 15.5 Neuroleptic malignant syndrome (NMS) and serotonoergic syndrome (SS) 131 15.6 Discontinuation syndrome 131 15.7 Lithium toxicity 132 Chapter 16: Managing violence and aggression 133 Chapter 17: Managing your own mental health 136 Fact sheets for you to photocopy 1. My crisis plan 137 2. Sleep hygiene 138 3. Relaxation techniques 139 4. Epilepsy 140 5. Dementia 141 6. Psychosis 142 7. Depression 143 8. Mania 144 9. Mental retardation 145 10. Delirium 146 Appendices 1. The safe administration of medicines for mental illness 147 2. Emergency treatment of physical illness 164 Bibliography 169 8 Foreword How to use this manual This manual has been designed to provide you with the essential information you need to help people with mental illness. It does not tell you the solution to every problem you may face, but it will hopefully show you how to deal with most situations. It will also let you know when you need to get extra help. This will mean that you can provide good, safe care to all the people you work with. We also hope it will prevent any worries you may have and will help you to enjoy your work! This manual is aimed to help the work of all mental health professionals . The initial chapters provide an introduction to mental health (experienced professionals may wish to use these chapters to teach others). The later chapters and the appendices will be of more use to experienced health professionals who prescribe medicine. Some information in this manual may be new to even experienced health professionals, particularly regarding the use of medicines. When writing this book we collected the most up-to-date research and guidelines on what treatments work for mental illness. We have then compared this information with the treatments that are available in Ghana today to make our recommendations. The main aim of this manual is to help you in your work. If you provide effective treatments that are proven to work, the people you help will get better more quickly and everybody’s life will be easier! At the end of the manual there are some fact sheets about some of the mental illnesses, and other ways you can help people. Please feel free to photocopy these fact sheets and give them to the people you help and to their families. If a person is not able to read you can tell the person what the fact sheet says and ask them to memorise it. The fact sheets can also be downloaded and printed out from the following website: www.basicneeds.org We would be very grateful for any comments about this manual. It is always nice to know when people have enjoyed reading it, but also please do not be afraid to let us know of ways we can improve the manual. Please send any comments to: Every day around the world people are being Basic Needs Ghana helped free from the chains of mental illness. We 108/20 Osabu Street would like to thank you for your part in this work Abelenkpe and wish you all the very best! PO Box AT1603 Achimota-Accra The Basic Needs Team Ghana Email: [email protected] 9 DON’T PANIC! Having a crisis plan Often when people start a new job they worry about facing problems they do not know how to deal with. This is called a crisis. At some stage when you are helping people with mental illness you will have a crisis. However don’t panic! You can very easily come up with your own plan to deal with any crisis. The first thing to do is to sit down when things are calm and work out who you are going to speak to when there is a crisis. Next, think about what you would do if that person is not around. This is called imagining the ‘worst case scenario’. Once again however we do not panic. We calmly think again of another person we can go to for help or we think of something else we can do.
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